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Biomedical subjects

C Reit

Publications and source records attributed to C Reit.

At least 19 recordsLinked to original sources
PubMed2000

Identification and antimicrobial susceptibility of enterococci isolated from the root canal.

Enterococci are occurring in opportunistic infections involving the oral cavity. This study has identified enterococcal species in 29 endodontic infections undergoing treatment with Ca (OH)2 dressings. The in vitro antimicrobial susceptibility of 29 isolated enterococcal strains was determined. Enterococcus faecalis was speciated for 26 isolates and Enterococcus faecium for three isolates. In vitro antimicrobial susceptibility testing revealed enterococcal isolates resistant to benzylpenicillin, ampicillin, clindamycin, metronidazole and tetracycline but sensitive to erythromycin and vancomycin. Due to low sensitivity to antimicrobial agents, enterococci may be selected in root canals undergoing standard endodontic treatment and significantly contribute to endodontic treatment failures.

Ampicillin↗
PubMed2000

Postoperative discomfort associated with surgical and nonsurgical endodontic retreatment.

Endodontic retreatment decision-making must include an appraisal of the costs of the different strategies proposed. In addition to direct costs, postoperative discomfort may have other consequences in terms of time off work, unscheduled visits and suffering. To establish a foundation for the appraisal of such indirect and intangible costs the present study was set up in which patients' assessments of pain and swelling after surgical and nonsurgical retreatment procedures were recorded. Ninety-two patients with 95 root-filled incisors and canine teeth exhibiting apical periodontitis were included in the study. The mode of retreatment was randomly assigned. Each day during the first post-treatment week patients assessed their degree of swelling and pain on horizontal 100-mm visual analog scales (VAS). The scales ranged from "no swelling" to "very severe swelling" and "no pain" to "intolerable pain", respectively. Consumption of self-prescribed analgesics and time off work were also recorded. Significantly more patients reported discomfort after surgical retreatment than after nonsurgical procedures. High pain scores were most frequent on the operative day while swelling reached its maximum on the first postoperative day followed by progressive decrease both in frequency and magnitude. Postoperative symptoms associated with nonsurgical retreatment were less frequent but reached high VAS values in single cases. Analgesics were significantly more often consumed after periapical surgery. Patients reported absence from work mainly due to swelling and discoloration of the skin. This was found to occur only after surgical retreatment. Conclusively, surgical retreatment resulted in more discomfort and tended to bring about greater indirect costs than nonsurgical retreatment.

Decision Making↗
PubMed1999

Results of endodontic retreatment: a randomized clinical study comparing surgical and nonsurgical procedures.

Information of "success" rates after surgical or nonsurgical endodontic retreatment is abundant but inconclusive. Reported healing frequencies vary between 45% and 90%. The present study was designed to find any systematic difference between the methods. Nonsurgical and surgical retreatment was randomly assigned to 95 endodontically "failed" cases. The outcome of the procedures was clinically and radiographically recorded, and followed for 4 years. At the 12-month recall, a statistically significant (p < 0.05) higher healing rate was observed for cases surgically retreated. At the final 48-month examination, no such difference was found. These findings may be explained by (a) slower healing dynamics in the nonsurgical group and (b) the event of late "failures" in the surgical group. Within the latter category, four cases classified as healed after 1 yr failed at the final follow-up. Conclusively, this study failed to show any systematic difference in the outcome of surgical and nonsurgical endodontic retreatment. Surgical retreatment seems to result in more rapid periapical bone fill, but also may imply a higher risk of "late failures." From a scientific point of view, the length of the follow-up period is very important and may strongly influence the conclusions made.

Adolescent↗
PubMed1999

The antimicrobial effect of calcium hydroxide in root canals pretreated with 5% iodine potassium iodide.

Calcium hydroxide (CH) is often used as a routine interappointment dressing during the endodontic treatment of teeth with apical periodontitis. However, it fails to consistently produce sterile root canals. The present study was set up to find out whether an antimicrobial strategy including the use of CH could be made more effective if: 1) canals were pretreated with 5% iodine potassium iodide (IPI), and 2) the dressing period was extended up to 2 months. Fifty human teeth, with radiographically verified apical periodontitis, were microbiologically sampled. After chemomechanical preparation the canals were pretreated with IPI for 3-7 days. Teeth where microorganisms persisted were then treated with CH for 2 months. Following instrumentation and dressing with IPI, 43 bacterial strains were recovered in 22 of the teeth. Samples obtained after the CH dressing period disclosed growth of 13 facultative and two strict anaerobic strains in 10 teeth. Enterococcus faecalis was identified in two specimens. In conclusion, the present study gave no evidence for an increased antimicrobial effect of CH if it was left for longer periods in the root canal. Although pretreatment with IPI from a quantitative point of view did not seem to add antimicrobial power, it might reduce the frequency of persisting strains of E. faecalis.

Adult↗
PubMed1999

The diagnostic accuracy of microbiologic root canal sampling and the influence of antimicrobial dressings.

The routine approach to endodontic treatment of teeth with apical periodontitis often involves an interappointment dressing with calcium hydroxide. However, investigations have demonstrated a negative influence of calcium hydroxide on the accuracy of microbiological root canal sampling (MRS). The aim of the present study was to investigate whether the use of a fluid dressing like 5% iodine potassium iodide (IPI) would increase the accuracy of MRS. Following instrumentation of 50 teeth with radiographically verified apical periodontitis the root canals received IPI as an intracanal dressing. One week after closure canals were sampled, "test sample" (TS), and then left filled with sampling fluid and temporarily scaled. Seven days later a "gold standard" (GS) sample was obtained. Bacteria were recovered in 22 teeth (44%) in TS as well as in GS. Fifteen teeth (30%) were positive for growth in both samples. Using the detection level "very sparse growth" of microbes the sensitivity and specificity of MRS reached 68% and 75%, respectively. In an earlier study, following the same experimental protocol, but with calcium hydroxide as intracanal dressing, the corresponding values were 33% and 81%. In 25% of these cases bacteria persisted in the canals. As compared to calcium hydroxide, the use of IPI resulted in improved test accuracy, but loss of antibacterial capacity. Conclusively, intracanal dressings seem to vary in their influence on the microbiologic test performance as well as in their antibacterial efficacy. In a clinical situation the choice of interappointment dressing should include consideration of these potentially conflicting properties.

Adult↗
PubMed1998

Endodontic retreatment behaviour: the influence of disease concepts and personal values.

To explain dentists' variation in endodontic retreatment decision making a praxis concept (PC) has been generated. PC assumes that practitioners operate along a health continuum. Various periapical conditions are then perceived as different stages on a continuous health scale, based on their radiographic appearance. PC suggests that an individual's placement of a cut-off point for retreatment on the health continuum to a large extent is dependent on the agent's personal values. In the present study value judgements (utilities) concerning two periapical health states in endodontically treated teeth were investigated among 82 dental students. The two methods used to elicit utilities, a Visual Analogue Scale (VAS) and the Standard Gamble (SG), produced large inter- and intra-individual variations. VAS frequently generated lower utility values. The results obtained in the study satisfy a necessary criterion for the validity of PC and strengthen the position of the theory.

Attitude of Health Personnel↗
PubMed1998

Microbiological status of root-filled teeth with apical periodontitis.

The present study examined the microbiological status of 100 root-filled teeth with radiographically verified apical periodontitis--the pathology (P) group--and of 20 teeth without signs of periapical pathosis--the technical (T) group. In the P group 117 strains of bacteria were recovered in 68 teeth. In most of the cases examined one or two strains were found. Facultative anaerobic species predominated among these isolates (69% of identified strains). Growth was classified as 'sparse' or 'very sparse' in 53%, and as 'heavy' or 'very heavy' in 42%. Enterococci were the most frequently isolated genera, showing 'heavy' or 'very heavy' growth in 25 out of 32 cases (78%). In 11 teeth of the T group no bacteria were recovered, whilst the remaining nine yielded 13 microbial strains. Eight of these grew 'very sparsely'. It is concluded that the microflora of the obturated canal differs from that found normally in the untreated necrotic dental pulp, quantitatively as well as qualitatively. Nonsurgical retreatment strategies should be reconsidered.

Bacteria, Anaerobic↗
PubMed1996

Microbiological root canal sampling: diffusion of a technology.

Diffusion is the process whereby a technology enters and becomes part of the health-care system. In the present study, diffusion of microbiological root canal sampling (MRS) among general dental practitioners within the city of Gothenburg was observed for 25 years, from the establishment of the Laboratory of Oral Microbiology in 1966. Laboratory records at 5-year intervals were analysed and adopters were categorized as 'occasional' (1-2 samples/year), 'selective' (3-10) or 'regular' (> 10) samples. The diagnostic accuracy was assessed by analysing the results of culturing 574 samples referred in 1986. The acceptance rate varied between 2.9 and 5.1% except in 1986 when 10.1% of the practitioners in the area referred root-canal samples. While a minority of the adopters used MRS as a standard procedure, the strategy appeared to be directed towards selection of special cases. The results of culturing revealed a predominance of facultatives. Although evidence of contamination was found, the practitioners frequently appeared to produce valid microbiological samples.

Bacteriological Techniques↗
PubMed1996

Reasons for dentists' acceptance or rejection of microbiological root canal sampling.

Microbiological root canal sampling (MRS) has been found to be used by only a few Swedish general dentists. The present study addresses the reasons for their acceptance or rejection of the technology. A questionnaire was mailed to 240 general dentists practising within the city of Göteborg. The questionnaire concerned certain practice characteristics and attitudes to MRS. The data showed that MRS is mainly performed by dentists working with adult patients in private practice. The technology is rarely used routinely, but is applied in selected cases. The main reason for non-adoption seems to be a perceived lack of relative advantage over conventional treatment strategies. Furthermore, opinions regarding the complexity and observability of the technology appear to influence acceptance significantly.

Attitude of Health Personnel↗
PubMed1994

Prescribing endodontic retreatment: towards a theory of dentist behaviour.

The large variations observed in dentists' management of periapical lesions in endodontically treated teeth suggest that disease concepts used in clinical practice should be investigated. In the present study it was hypothesized that dentists regard various periapical conditions as different stages on a health continuum. Variations could then be regarded as the result of the individuals selection of differing cut-off points for prescribing retreatment. The hypothesized decision-making model was tested using dental students in Amsterdam (Holland), Gothenburg (Sweden) and Pavia (Italy). The students were shown six simulated cases among which the quality of root filling seal and presence of post and crown were systematically varied. For each case, management of five periapical conditions was assessed. Five options were offered: no therapy, wait-and-see, nonsurgical retreatment, surgical retreatment, and extraction. For each examiner and case a 'retreatment preference score (RPS)' was established. The investigation showed large interindividual variations in RPS. A statistically significant higher mean RPS was seen among students in Pavia compared with students in Amsterdam and Gothenburg. Among all observers and cases it was found that if retreatment was proposed for a certain size of lesion, retreatment was subsequently selected for all larger lesions. The experiment gave evidence in support of the proposed hypothesis. The data also suggest that the choice of retreatment criterion is affected by values, costs of retreatment and technical quality of the original treatment.

Adult↗
PubMed1990

Microbiological evaluation of clindamycin as a root canal dressing in teeth with apical periodontitis.

The present investigation was designed to study the effect of clindamycin on root canal infection when placed as an intracanal dressing. Twenty-five teeth with necrotic pulps and periapical radiolucencies were included. Following initial bacteriological sampling and routine instrumentation, clindamycin powder mixed to a paste with saline was applied for 14 days. The presence or absence of bacteria was determined in samples taken immediately after removal of the dressing, and after a period of 7 days during which the canals were filled with sampling fluid. Bacteria were recovered from four and six teeth respectively. The results indicated that clindamycin offered no advantage over conventional root canal dressings, such as calcium hydroxide, and it is therefore not recommended for use in routine endodontic therapy.

Clindamycin↗
PubMed1989

The relative frequency of periapical lesions in teeth with root canal-retained posts.

This study was concerned with the relation between technical quality of root filling seal in teeth with posts and radiographic status of the periapical tissues. Full-mouth series from 298 randomly chosen patients were examined by two observers. Endodontic treatment had been performed in 852 roots and posts were observed in 424 of these. Periapical radiolucencies were judged to be present in 16% of roots with posts and in 13% of roots without posts. Roots with posts in which the remaining root filling was shorter than 3 mm showed a statistically significant higher frequency of periapical radiolucencies (p less than 0.01). It was found that an improper seal was more unfavorable in roots with posts (p less than 0.05). The findings in this study indicate that the placement of a post will not per se decrease the probability of periapical healing. It also suggests that the remaining root filling must not be shorter than 3 mm.

Chi-Square Distribution↗
PubMed1989

Emergency pulpotomy: pain relieving effect with and without the use of sedative dressings.

Seventy-three teeth with acute irreversible pulpitis were subjected to emergency pulpotomies. After removal of the coronal portion of the pulp, a sterile cotton pellet or zinc oxide-eugenol cement was placed against the remaining pulp tissue. The cotton pellet was either dry or moistened with camphorated phenol, cresatin, eugenol, or isotonic saline. This gave six different groups of treatment following the pulpotomy. All teeth were sealed with zinc oxide-eugenol cement. By means of questionnaires, symptoms were recorded after the anesthetic effect was gone and also at 1, 7, and 30 days after treatment. A total of 70 patients (96%) reported pain relief. Three patients did not experience relief and returned for pulpectomy. After the first postoperative day, no pain was reported by any of the patients. The frequency of discomfort decreased from 11% 1 day postoperatively to 1% 30 days after the emergency treatment. There was no difference in recorded symptoms among the six treatment groups. Thus, removal of caries, pulpotomy, and sealing of the cavity apparently was a reliable means to relieve pain. The use of the various dressings did not contribute to the relief of pain.

Analgesics↗
PubMed1988

Endodontic retreatment decision making among a group of general practitioners.

Large interindividual variations have been demonstrated when dentists suggest clinical management of endodontically treated teeth. Since variations also have been shown in radiographic diagnosis of the periapical tissues, a hypothesis was tested that explains variation in treatment as a function of variation in diagnosis. Fifty-four general practitioners suggested diagnosis and management of 32 endodontically treated roots. Spearman's rank correlation coefficient reached 0.298 when the examiners were definitely sure of the presence of a periapical lesion, and 0.356 when probable lesions also were included. Conclusively, the hypothesis seemed to have a limited value in explaining why dentists carry out retreatment. Instead a multi-aspect approach to this problem is suggested.

Attitude of Health Personnel↗